Provider Demographics
NPI:1326362682
Name:THOMPSON, TAMMY
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7214 SWEENEY RD
Mailing Address - Street 2:
Mailing Address - City:GREIG
Mailing Address - State:NY
Mailing Address - Zip Code:13345-1828
Mailing Address - Country:US
Mailing Address - Phone:315-348-6172
Mailing Address - Fax:
Practice Address - Street 1:7518 S STATE ST
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1531
Practice Address - Country:US
Practice Address - Phone:315-376-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145803164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse